Психология

more to be sure that we really did turn off the sink faucet or checking the mirror a couple of times to be sure that our hair is combed are not necessarily bad ideas.

Obsessive-compulsive disorder (OCD) is a psychological disorder that is diagnosed when an individual continuously experiences distressing or frightening thoughts, and engages

in obsessions (repetitive thoughts) orcompulsions (repetitive behaviors) in an attempt to calm these thoughts. OCD is diagnosed when the obsessive thoughts are so disturbing and the compulsive behaviors are so time consuming that they cause distress and significant dysfunction in a person‘s everyday life. Washing your hands once or even twice to make sure that they are clean is normal; washing them 20 times is not. Keeping your fridge neat is a good idea; spending hours a day on it is not. The sufferers know that these rituals are senseless, but they cannot bring themselves to stop them, in part because the relief that they feel after they perform them acts as a reinforcer, making the behavior more likely to occur again.

Sufferers of OCD may avoid certain places that trigger the obsessive thoughts, or use alcohol or drugs to try to calm themselves down. OCD has a low prevalence rate (about 1% of the population in a given year) in relation to other anxiety disorders, and usually develops in adolescence or early adulthood (Horwath & Weissman, 2000; Samuels & Nestadt, 1997). [10] The course of OCD varies from person to person. Symptoms can come and go, decrease, or worsen over time.

Posttraumatic Stress Disorder (PTSD)

“If you imagine burnt pork and plastic; I can still taste it,‖ says Chris Duggan, on his experiences as a soldier in the Falklands War in 1982. “These helicopters were coming in and we were asked to help get the boys off…when they opened the doors the stench was horrendous.‖

When he left the army in 1986, he suffered from PTSD. “I was a bit psycho,‖ he says. “I was verbally aggressive, very uncooperative. I was arguing with my wife, and eventually we divorced. I decided to change the kitchen around one day, get all new stuff, so I threw everything

out of the window. I was 10 stories up in a flat. I poured brandy all over the video and it melted. I flooded the bathroom.‖ (Gould, 2007) [11]

People who have survived a terrible ordeal, such as combat, torture, sexual assault, imprisonment, abuse, natural disasters, or the death of someone close to them may

develop posttraumatic stress disorder (PTSD). The anxiety may begin months or even years after the event. People with PTSD experience high levels of anxiety along with reexperiencing the trauma (flashbacks), and a strong desire to avoid any reminders of the event. They may lose interest in things they used to enjoy; startle easily; have difficulty feeling affection; and may experience terror, rage, depression, or insomnia. The symptoms may be felt especially when approaching the area where the event took place or when the anniversary of that event is near.

PTSD affects about 5 million Americans, including victims of the 9/11 terrorist attacks, the wars in Afghanistan and Iraq, and Hurricane Katrina. Sixteen percent of Iraq war veterans, for example, reported experiencing symptoms of PTSD (Hoge & Castro, 2006). [12] PTSD is a frequent outcome of childhood or adult sexual abuse, a disorder that has its own Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis. Women are more likely to develop PTSD than men (Davidson, 2000). [13]

Risk factors for PTSD include the degree of the trauma‘s severity, the lack of family and community support, and additional life stressors (Brewin, Andrews, & Valentine, 2000). [14] Many people with PTSD also suffer from another mental disorder, particularly

depression, other anxiety disorders, and substance abuse (Brady, Back, & Coffey, 2004). [15]

Dissociative Disorders: Losing the Self to Avoid Anxiety

On October 23, 2006, a man appeared on the television show Weekend Today and asked America to help him rediscover his identity. The man, who was later identified as Jeffrey Alan Ingram, had left his home in Seattle on September 9, 2006, and found himself in Denver a few days later, without being able to recall who he was or where he lived. He was reunited with family after

being recognized on the show. According to a coworker of Ingram‘s fiancée, even after Ingram was reunited with his fiancée, his memory did not fully return. “He said that while her face wasn‘t familiar to him, her heart was familiar to him…He can‘t remember his home, but he said their home felt like home to him.‖

People who experience anxiety are haunted by their memories and experiences, and although they desperately wish to get past them, they normally cannot. In some cases, however, such as with Jeffrey Ingram, people who become overwhelmed by stress experience an altered state of consciousness in which they become detached from the reality of what is happening to them.

A dissociative disorder is a condition that involves disruptions or breakdowns of memory, awareness, and identity. The dissociation is used as a defense against the trauma.

Dissociative Amnesia and Fugue

Dissociative amnesia is a psychological disorder that involves extensive, but selective, memory loss, but in which there is no physiological explanation for the forgetting (van der Hart & Nijenhuis, 2009). [16] The amnesia is normally brought on by a trauma—a situation that causes such painful anxiety that the individual “forgets‖ in order to escape. These kinds of trauma include disasters, accidents, physical abuse, rape, and other forms of severe stress (Cloninger & Dokucu, 2008). [17] Although the personality of people who are experiencing dissociative amnesia remains fundamentally unchanged—and they recall how to carry out daily tasks such as reading, writing, and problem solving—they tend to forget things about their personal lives—for instance, their name, age, and occupation—and may fail to recognize family and friends (van der Hart & Nijenhuis, 2009). [18]

A related disorder, dissociative fugue, is a psychological disorder in which an individual loses complete memory of his or her identity and may even assume a new one, often far from home. The individual with dissociative fugue experiences all the symptoms of dissociative amnesia but also leaves the situation entirely. The fugue state may last for just a matter of hours or may continue for months, as it did with Jeffrey Ingram. Recovery from the fugue state tends to be

rapid, but when people recover they commonly have no memory of the stressful event that triggered the fugue or of events that occurred during their fugue state (Cardeña & Gleaves, 2007). [19]

Dissociative Identity Disorder

You may remember the story of Sybil (a pseudonym for Shirley Ardell Mason, who was born in 1923), a person who, over a period of 40 years, claimed to possess 16 distinct personalities. Mason was in therapy for many years trying to integrate these personalities into one complete self. A TV movie about Mason‘s life, starring Sally Field as Sybil, appeared in 1976.

Sybil suffered from the most severe of the dissociative disorders, dissociative identity

disorder. Dissociative identity disorder is a psychological disorder in which two or more distinct and individual personalities exist in the same person, and there is an extreme memory disruption regarding personal information about the other personalities (van der Hart & Nijenhuis,

2009). [20] Dissociative identity disorder was once known as “multiple personality disorder,‖ and this label is still sometimes used. This disorder is sometimes mistakenly referred to as schizophrenia.

In some cases of dissociative identity disorder, there can be more than 10 different personalities in one individual. Switches from one personality to another tend to occur suddenly, often triggered by a stressful situation (Gillig, 2009). [21] The host personality is the personality in control of the body most of the time, and thealter personalities tend to differ from each other in terms of age, race, gender, language, manners, and even sexual orientation (Kluft, 1996). [22] A shy, introverted individual may develop a boisterous, extroverted alter personality. Each personality has unique memories and social relationships (Dawson, 1990).[23] Women are more frequently diagnosed with dissociative identity disorder than are men, and when they are diagnosed also tend to have more “personalities‖ (American Psychiatric Association, 2000). [24]

The dissociative disorders are relatively rare conditions and are most frequently observed in adolescents and young adults. In part because they are so unusual and difficult to diagnose, clinicians and researchers disagree about the legitimacy of the disorders, and particularly about dissociative identity disorder. Some clinicians argue that the descriptions in the DSM accurately reflect the symptoms of these patients, whereas others believe that patients are faking, roleplaying, or using the disorder as a way to justify behavior (Barry-Walsh, 2005; Kihlstrom, 2004; Lilienfeld & Lynn, 2003; Lipsanen et al., 2004).[25] Even the diagnosis of Shirley Ardell Mason (Sybil) is disputed. Some experts claim that Mason was highly hypnotizable and that her therapist unintentionally “suggested‖ the existence of her multiple personalities (Miller & Kantrowitz, 1999). [26]

Explaining Anxiety and Dissociation Disorders

Both nature and nurture contribute to the development of anxiety disorders. In terms of our evolutionary experiences, humans have evolved to fear dangerous situations. Those of us who had a healthy fear of the dark, of storms, of high places, of closed spaces, and of spiders and snakes were more likely to survive and have descendants. Our evolutionary experience can account for some modern fears as well. A fear of elevators may be a modern version of our fear of closed spaces, while a fear of flying may be related to a fear of heights.

Also supporting the role of biology, anxiety disorders, including PTSD, are heritable (Hettema, Neale, & Kendler, 2001), [27] and molecular genetics studies have found a variety of genes that are important in the expression of such disorders (Smoller et al., 2008; Thoeringer et al.,

2009). [28]Neuroimaging studies have found that anxiety disorders are linked to areas of the brain that are associated with emotion, blood pressure and heart rate, decision making, and action monitoring (Brown & McNiff, 2009; Damsa, Kosel, & Moussally, 2009). [29] People who experience PTSD also have a somewhat smaller hippocampus in comparison with those who do not, and this difference leads them to have a very strong sensitivity to traumatic events (Gilbertson et al., 2002). [30]

Whether the genetic predisposition to anxiety becomes expressed as a disorder depends on environmental factors. People who were abused in childhood are more likely to be anxious than those who had normal childhoods, even with the same genetic disposition to anxiety sensitivity (Stein, Schork, & Gelernter, 2008). [31] And the most severe anxiety and dissociative disorders, such as PTSD, are usually triggered by the experience of a major stressful event. One problem is that modern life creates a lot of anxiety. Although our life expectancy and quality of life have improved over the past 50 years, the same period has also created a sharp increase in anxiety levels (Twenge, 2006). [32]These changes suggest that most anxiety disorders stem from perceived, rather than actual, threats to our well-being.

Anxieties are also learned through classical and operant conditioning. Just as rats that are shocked in their cages develop a chronic anxiety toward their laboratory environment (which has become a conditioned stimulus for fear), rape victims may feel anxiety when passing by the scene of the crime, and victims of PTSD may react to memories or reminders of the stressful event. Classical conditioning may also be accompanied by stimulus generalization. A single dog bite can lead to generalized fear of all dogs; a panic attack that follows an embarrassing moment in one place may be generalized to a fear of all public places. People‘s responses to their anxieties are often reinforced. Behaviors become compulsive because they provide relief from the torment of anxious thoughts. Similarly, leaving or avoiding fear-inducing stimuli leads to feelings of calmness or relief, which reinforces phobic behavior.

In contrast to the anxiety disorders, the causes of the dissociative orders are less clear, which is part of the reason that there is disagreement about their existence. Unlike most psychological orders, there is little evidence of a genetic predisposition; they seem to be almost entirely environmentally determined. Severe emotional trauma during childhood, such as physical or sexual abuse, coupled with a strong stressor, is typically cited as the underlying cause (Alpher, 1992; Cardeña & Gleaves, 2007). [33] Kihlstrom, Glisky, and Angiulo (1994) [34] suggest that people with personalities that lead them to fantasize and become intensely absorbed in their own personal experiences are more susceptible to developing dissociative disorders under stress.

Dissociative disorders can in many cases be successfully treated, usually by psychotherapy (Lilienfeld & Lynn, 2003). [35]

K EY TA KEA WAY S

Anxiety is a natural part of life, but too much anxiety can be debilitating. Every year millions of people suffer from anxiety disorders.

People who suffer from generalized anxiety disorder experience anxiety, as well as a variety of physical symptoms.

Panic disorder involves the experience of panic attacks, including shortness of breath, heart palpitations, trembling, and dizziness.

Phobias are specific fears of a certain object, situation, or activity. Phobias are characterized by their specificity and their irrationality.

A common phobia is social phobia, extreme shyness around people or discomfort in social situations.

Obsessive-compulsive disorder is diagnosed when a person’s repetitive thoughts are so disturbing and their compulsive behaviors so time consuming that they cause distress and significant disruption in a person’s everyday life.

People who have survived a terrible ordeal, such as combat, torture, rape, imprisonment, abuse, natural disasters, or the death of someone close to them, may develop PTSD.

Dissociative disorders, including dissociative amnesia and dissociative fugue, are conditions that involve disruptions or breakdowns of memory, awareness, and identity. The dissociation is used as a defense against the trauma.

Dissociative identity disorder, in which two or more distinct and individual personalities exist in the same person, is relatively rare and difficult to diagnose.

Both nature and nurture contribute to the development of anxiety disorders.

EXE RCIS ES AND CRI T IC AL THINKI NG

1.Under what situations do you experience anxiety? Are these experiences rational or irrational? Does the anxiety keep you from doing some things that you would like to be able to do?

2.Do you or people you know suffer from phobias? If so, what are the phobias and how do you think the phobias began? Do they seem more genetic or more environmental in origin?

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[2]Chase. (2010, February 28). Re: “anxiety?” [Online forum comment]. Mental Health Forum. Retrieved from http://www.mentalhealthforum.net/forum/showthread.php?t=9359

[3]Kessler, R., Chiu, W., Demler, O., & Walters, E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–27; Robins, L., & Regier, D. A. (1991).Psychiatric disorders in America: The Epidemiologic Catchment Area Study. New York, NY: Free Press.

[4]Rubio, G., & Lopez-Ibor, J. (2007). Generalized anxiety disorder: A 40-year follow up study. Acta Psychiatric Scandinavica, 115, 372–379.

[5]Ceejay. (2006, September). My dance with panic [Web log post]. Panic Survivor. Retrieved

from http://www.panicsurvivor.com/index.php/2007102366/Survivor-Stories/My-Dance-With-Panic.html

[6]MacLeod, C., Rutherford, E., Campbell, L., Ebsworthy, G., & Holker, L. (2002). Selective attention and emotional vulnerability: Assessing the causal basis of their association through the experimental manipulation of attentional bias. Journal of Abnormal Psychology, 111(1), 107–123.

[7]American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

[8]Fredrikson, M., Annas, P., Fischer, H., & Wik, G. (1996). Gender and age differences in the prevalence of specific fears and phobias. Behaviour Research and Therapy, 34(1), 33–39. doi:10.1016/0005-7967(95)00048-3; Kessler, R., Meron-Ruscio, A., Shear, K., & Wittchen, H. (2009). Epidemiology of anxiety disorders. In M. Anthony, & M. Stein (Eds).Oxford handbook of anxiety and related disorders. New York, NY: Oxford University Press.

[9]Dolan, A. (2006, April 3). The obsessive disorder that haunts my life. Daily Mail. Retrieved

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[10] Horwath, E., & Weissman, M. (2000). The epidemiology and cross-national presentation of obsessive-compulsive disorder. Psychiatric Clinics of North America, 23(3), 493–507. doi:10.1016/S0193-953X(05)70176-3; Samuels, J., & Nestadt, G. (1997). Epidemiology and genetics of obsessive-compulsive disorder. International Review of Psychiatry, 9, 61–71.

[11]Gould, M. (2007, October 10). You can teach a man to kill but not to see dying. The Guardian. Retrieved fromhttp://www.guardian.co.uk/society/2007/oct/10/guardiansocietysupplement.socialcare2

[12]Hoge, C., & Castro, C. (2006). Post traumatic stress disorder in UK and U.S. forces deployed to Iraq. Lancet, 368, 867.

[13]Davidson, J. (2000). Trauma: The impact of post-traumatic stress disorder. Journal of Psychopharmacology, 14(2 Suppl 1), S5–S12.

[14]Brewin, C., Andrews, B., & Valentine, J. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in traumaexposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748–766. doi:10.1037//0022-006X.68.5.748

[15]Brady, K. T., Back, S. E., & Coffey, S. F. (2004). Substance abuse and posttraumatic stress disorder. Current Directions in Psychological Science, 13(5), 206–209.

[16]van der Hart, O., & Nijenhuis, E. R. S. (2009). Dissociative disorders. In P. H. Blaney & T. M. Millon (Eds.), Oxford textbook of psychological disorder (2nd ed., pp. 452–481). New York, NY: Oxford University Press.

[17]Cloninger, C., & Dokucu, M. (2008). Somatoform and dissociative disorders. In S. H. Fatemi & P. J. Clayton (Eds.), The medical basis of psychiatry (3rd ed., pp. 181–194). Totowa, NJ: Humana Press. doi:10.1007/978-1-59745-252-6_11

[18]van der Hart, O., & Nijenhuis, E. R. S. (2009). Dissociative disorders. In P. H. Blaney & T. M. Millon (Eds.), Oxford textbook of psychological disorder (2nd ed., pp. 452–481). New York, NY: Oxford University Press.

[19]Cardeña, E., & Gleaves, D. (2007). Dissociative disorders. In M. M. Hersen, S. M. Turner, & D. C. Beidel (Eds.), Adult psychological disorder and diagnosis (5th ed., pp. 473–503). Hoboken, NJ: John Wiley & Sons.

[20]van der Hart, O., & Nijenhuis, E. R. S. (2009). Dissociative disorders. In P. H. Blaney, & T. M. Millon (Eds.), Oxford textbook of psychological disorder (2nd ed., pp. 452–481). New York, NY: Oxford University Press.

[21]Gillig, P. M. (2009). Dissociative identity disorder: A controversial diagnosis.Psychiatry, 6(3), 24–29.

[22]Kluft, R. P. (1996). The diagnosis and treatment of dissociative identity disorder. InThe Hatherleigh guide to psychiatric disorders (1st ed., Vol. 1, pp. 49–96). New York, NY: Hatherleigh Press.

[23]Dawson, P. L. (1990). Understanding and cooperation among alter and host personalities. American Journal of Occupational Therapy, 44(11), 994–997.

[24]American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

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[26]Miller, M., & Kantrowitz, B. (1999, January 25). Unmasking Sybil: A reexamination of the most famous psychiatric patient in history. Newsweek, pp. 11–16.

[27]Hettema, J. M., Neale, M. C., & Kendler, K. S. (2001). A review and meta-analysis of the genetic epidemiology of anxiety disorders. The American Journal of Psychiatry, 158(10), 1568–1578.

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[29]Brown, T., & McNiff, J. (2009). Specificity of autonomic arousal to DSM-IV panic disorder and posttraumatic stress disorder. Behaviour Research and Therapy, 47(6), 487–493. doi:10.1016/j.brat.2009.02.016; Damsa, C., Kosel, M., & Moussally, J. (2009). Current status of brain imaging in anxiety disorders. Current Opinion in Psychiatry, 22(1), 96–110. doi:10.1097/YCO.0b013e328319bd10

[30]Gilbertson, M. W., Shenton, M. E., Ciszewski, A., Kasai, K., Lasko, N. B., Orr, S. P.,…Pitman, R. K. (2002). Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Nature Neuroscience, 5(11), 1242.

[31]Stein, M., Schork, N., & Gelernter, J. (2008). Gene-by-environment (serotonin transporter and childhood maltreatment) interaction for anxiety sensitivity, an intermediate phenotype for anxiety disorders. Neuropsychopharmacology, 33(2), 312–

319. doi:10.1038/sj.npp.1301422

[32]Twenge, J. (2006). Generation me. New York, NY: Free Press.

[33]Alpher, V. S. (1992). Introject and identity: Structural-interpersonal analysis and psychological assessment of multiple personality disorder. Journal of Personality Assessment. 58(2), 347–367. doi:10.1207/s15327752jpa5802_12; Cardeña, E., & Gleaves, D. (2007). Dissociative disorders. In M. M. Hersen, S. M. Turner, & D. C. Beidel (Eds.), Adult psychological disorder and diagnosis (5th ed., pp. 473–503). Hoboken, NJ: John Wiley & Sons.